Hospital Universitario HM Madrid

HighlightsWhat are the main findings?Pediatric cancer survivors exhibit significant gait alterations compared with healthy peers, including slower walking speed, pelvic instability, reduced hip extension, knee hyperextension, and diminished ankle plantarflexor moments.These biomechanical deviations reflect persistent neuromuscular impairments likely related to chemotherapy-induced neurotoxicity and treatment-related deconditioning.What are the implications of the main findings?Instrumented 3D gait analysis provides an objective method to detect subtle locomotor deficits in childhood cancer survivors.Early identification of these abnormalities can guide targeted rehabilitation strategies to enhance long-term functional outcomes and quality of life.Background/Objectives: Pediatric cancer survivors frequently experience neuromuscular sequelae related to chemotherapy-induced neurotoxicity. Agents such as vincristine, methotrexate, and platinum compounds can lead to persistent gait alterations and sensorimotor deficits that impair mobility and quality of life. This study aimed to objectively assess gait in pediatric cancer survivors after the completion of oncological pharmacological treatment to identify specific spatiotemporal, kinematic, and kinetic alterations and characterize neuromechanical patterns associated with neurotoxic exposure. Methods: A cross-sectional observational study was conducted including pediatric cancer survivors (6–18 years) who had completed chemotherapy and age- and sex-matched healthy controls. Gait was analyzed using a Vicon®3D motion capture system, with reflective markers placed on standardized anatomical landmarks. Spatiotemporal, kinematic, and kinetic variables were compared between groups using parametric tests and statistical parametric mapping (SPM) with Holm–Bonferroni correction (α = 0.05). Results: Pediatric cancer survivors showed slower gait velocity (Mean Difference (MD) = 0.17, p = 0.018, Confidence Interval CI95% = 0.04; 0.4), shorter step (MD = 0.1, p = 0.015, CI95% = 0.01; 0.19) and stride length (MD = 0.17, p = 0.018, CI95% = 0.03; 0.31), as well as reduced single support time (MD = 0.1, p = 0.043, CI95% = 0.01; 0.19), along with significant alterations in pelvic, hip, knee, and ankle kinematics compared with controls. Increased pelvic elevation (MD = 0.92, p = 0.018, CI95% = 0.25; 1.58), reduced hip extension during stance (MD = −2.99, p = 0.039, CI95% = −5.19; −0.74), knee hyperextension in mid-stance (MD = −3.84, p < 0.001, CI95% = −6.18; −0.72), and limited ankle dorsiflexion (MAS MD = −4.04, p < 0.001, CI95% = −6.79; −0.86, LAS MD = −3.16, p < 0.001) and plantarflexor moments in terminal stance (MAS MD = −149.65, p = 0.018, CI95% = −259.35; −48.25, LAS MD = −191.81, p = 0.008, CI95% = −323.81; −57.31) were observed. Ground reaction force peaks during loading response (MAS MD = −16.86, p < 0.001, CI95% = −26.12; −0.72 LAS MD = −11.74, p = 0.001, CI95% = −19.68; −3.94) and foot-off (MAS MD = 10.38, p = 0.015, CI95% = 0.41; 20.53, LAS MD = 11.88, p = 0.01, CI95% = 3.15; 22.38) were also reduced. Conclusions: Children who have completed chemotherapy present measurable gait deviations reflecting persistent neuromechanical impairment, likely linked to chemotherapy-induced neurotoxicity and deconditioning. Instrumented gait analysis allows early detection of these alterations and may support the design of targeted rehabilitation strategies to optimize functional recovery and long-term quality of life in pediatric cancer survivors.

Background/Objectives: High turnover and staff shortages in nursing pose challenges to professional integration and compromised patient safety. Structured onboarding programs are considered key strategies to enhance adaptation, reduce clinical errors, and promote retention. This study aimed to evaluate the impact of a structured onboarding program compared with the standard routine on early professional adaptation, safety culture, and satisfaction among newly hired nurses and nursing assistants. Methods: A prospective quasi-experimental study was conducted between 2022 and 2024 in three private hospitals in Madrid. A total of 200 newly hired health professionals (128 nurses and 72 assistants) were assigned alternately to either the intervention group (structured onboarding program) or the control group (usual routine). The intervention comprised three consecutive days of guided training with mentorship, simulation-based learning, and digital tool instruction. Adaptation was assessed with the validated GAML scale, and satisfaction was measured through a Likert survey one month later. Statistical analyses included Mann–Whitney U, Chi-squared tests, and linear regression. Results: The intervention group achieved significantly higher scores across all competency domains for both nurses and nursing assistants, with overall medians of 25 [22–27] and 22 [20–23.25], respectively, compared with notably lower values in the control groups (p < 0.001). The greatest improvements were observed in digital tool management, clinical protocol knowledge, problem-solving and decision-making, and patient safety practices, demonstrating the strong impact of the structured onboarding program. In terms of satisfaction, participants in the intervention group also reported higher ratings for the clarity and completeness of information, particularly regarding hospital structure, service-specific orientation, and occupational risk prevention. However, global satisfaction differences were more pronounced among nurses than nursing assistants. Conclusions: The structured onboarding program demonstrated substantial benefits in professional adaptation, safety culture, and perceived preparedness of newly hired staff. These findings support integrating standardized onboarding plans as part of hospital quality and safety strategies, requiring sustained leadership and resource investment for long-term success.

To assess the association between daytime napping, night sleeping time and the incidence of atrial fibrillation (AF) in a Mediterranean cohort. We conducted a prospective cohort study of Spanish university graduates (The SUN Project), involving 20,827 participants, free of AF at baseline. Participants were followed-up for a median of 15 years (retention proportion: 91%). Daytime nap and night sleep duration were assessed at baseline, and incident AF cases were confirmed by a cardiologist following a prespecified protocol. Multivariable Cox regression models estimated hazard ratios (HR) for AF according to sleeping patterns. During follow-up, 163 incident cases of AF were identified. Compared to participants who took short naps (<30 min/day), those with long naps (≥30 min/day) had a 62% higher risk of AF (adjusted HR= 1.62; 95% CI: 1.10, 2.39). No significant association was observed for participants who did not sleep a nap (adjusted HR = 1.32; 95% CI: 0.91, 1.93) compared to a short nap. In the same model, inadequate night sleep duration (<6 h/day or >8 h/day) had a higher risk of AF (adjusted HR = 1.89; 95% CI: 1.10, 3.23) compared to sleeping 6-8 h/day. The highest AF risk was observed in participants with both long naps (≥30 min/day) and inadequate nighttime sleep (<6 h/day or >8 h/day), with a threefold increased risk (adjusted HR = 3.19; 95% CI: 1.30, 7.79). Prolonged daytime naps and inadequate night sleep duration were significantly associated with a higher risk of AF in a Mediterranean cohort.

Wound healing is a dynamic process involving tissue formation, debris removal and ultimately remodeling to restore skin integrity. Although wound healing is generally successful, this process can eventually fail, leading to chronic wounds like pressure ulcers (PUs), whose presence/absence has been considered by WHO as good indicator of patient’s wellbeing and care quality. PUs are stratified into grades I to IV grades based on their severity, however, the existence of systemic markers predicting their clinical progression remains unexplored. Here, we performed a serum proteomic and transcriptomic profiling of 54 patients with PUs ranging from grade II to grade III-IV. Unsupervised clustering identified a distinctive immune-related proteomic and transcriptomic blood profile in high-grade PUs. Specifically, pathways controlled by inflammatory-linked genes such as IER3, TSLP, and TNFAIP6 (TSG-6) were found to be upregulated in high-grade PUs, together with a reduction in the levels of potent immunomodulators such as IL-10, IFNγ, MCP-2/CCL8, and CXCL-10 in serum from grade III-IV PUs patients. All together, indicating an altered inflammatory state in advanced PUs. This study provides novel insights regarding the use of omic approaches to find potential systemic biomarkers for the prediction of severity in PUs and could help to understand the molecular mechanisms underlying the chronic progression of this pathology.

BackgroundTraining in invasive procedures like pericardiocentesis is a critical component of medical education but poses significant challenges due to its complexity and infrequent clinical application. Pericardiocentesis is an invasive procedure used to remove excess pericardial fluid from the pericardial sac, typically performed to relieve cardiac tamponade. It requires precise anatomical knowledge, ultrasound guidance, and dexterous needle placement to minimize complications. Simulation-based training, particularly with innovative technologies such as 3D printing and virtual reality (VR), offers accessible and cost-effective solutions. This study compared the effectiveness of 3D-printed mannequins and VR simulations in pericardiocentesis training, focusing on learning outcomes, stress responses, and cognitive load.MethodsThirty-five final-year medical students participated in this quasi-experimental study, receiving training with both models in separate sessions under the supervision of two experienced instructors. Learning outcomes were evaluated using the objective structured clinical examination (OSCE), while stress responses were assessed via heart rate variability (HRV), a measure of fluctuations in heart rate that reflect stress levels. Perceived cognitive load was measured with the NASA Task Load Index (NASA-TLX). Wilcoxon signed-rank and Friedman tests were used for statistical analysis.ResultsThe 3D-printed mannequin outperformed VR in tasks requiring fine motor skills, such as material handling and drainage placement (Z = − 2.56, p < 0.05; Z = − 2.34, p < 0.05). VR training, however, was associated with lower mental demand and effort (Z = − 2.147, p < 0.05; Z = − 2.356, p < 0.05). Biometric analysis indicated higher stress levels during mannequin-based training (SD1/SD2, chi-square = 14.157, p < 0.01), reflecting its closer replication of real-life clinical conditions.ConclusionsBoth 3D-printed mannequins and VR simulations serve as effective tools for pericardiocentesis training, each offering unique advantages. The 3D-printed mannequin supports tactile skill acquisition, while VR enhances cognitive engagement in a low-stress environment. A hybrid approach—beginning with VR and progressing to 3D-printed models—maximizes training outcomes, particularly in resource-limited settings, where affordable simulation tools can improve access to medical education.

The objective of the article is to report the case of three patients with diffuse intrinsic pontine glioma (DIPG) treated with immunotherapy. In particular we report the data related to the treatments’ efficacy and tolerance.To achieve this, we review the medical records in the Paediatric Oncology and Haematology Unit of HM Hospitales/Centro Integral Oncológico Clara Campal (CIOCC). We focused on patients diagnosed with DIPG who were administered oncolytic viruses followed by immune checkpoint inhibitors (ICI) (pembrolizumab, anti PD-1) plus a concomitant antiangiogenic agent (bevacizumab).The results we obtained showed the three paediatric DIPG patients studied presented good tolerance, with disease stabilisation for approximately 5 months after immunotherapy. However, subsequent clinical worsening required clinicians to change the patients’ treatment.In conclusion, immunotherapy combined with other conventional antineoplastic treatments (chemotherapy, radiotherapy) is postulated as a very promising future therapeutic option. However, further research is warranted in the paediatric population to demonstrate safety and effectiveness.